CGM Coverage on Prince Edward Island
Does Prince Edward Island provide Dexcom CGM coverage?
Yes, Dexcom G7 and Dexcom G6 coverage is available for qualified patients.
Individuals are eligible if they:
- Are a PEI resident as defined by the Drug Cost Assistance Act;
- Have a valid PEI Health Card;
- Filed their most recent income tax return;
- Are diagnosed by a doctor, nurse practitioner or certified diabetes educator as having diabetes;
- Are reliant on an insulin pump or multiple daily injections of insulin (i.e. 3 or more) to manage their diabetes; and,
- Have a Glucose Sensor Program Initial Application Form completed, with the Special Authorization section signed by their doctor, nurse practitioner or certified diabetes educator.
Click PEI Glucose Sensor Program for a complete description of the coverage criteria and additional information on the program.
Do I need a prescription to qualify for coverage?
Yes, you will need a valid prescription for Dexcom G6 or G7 as part of the coverage approval process. In addition to your Doctor, a Certified Diabetes Educator (CDE) or Nurse Practitioner may also provide a prescription.
If you are switching from Dexcom G6 to Dexcom G7, you should obtain a new prescription for Dexcom G7 from your prescribing healthcare professional.
What do I need to get coverage approval?
First, a fully completed Glucose Sensor Program Initial Application Form must be submitted by mail to:
- Glucose Sensor Program Administrator
PEI Pharmacare
PO Box #2000
Charlottetown, PEI
C1N 7N8
You may download and print the application form from here or pick up a copy at your local Health PEI Diabetes Education Centre.
Within this initial application form, there is a one-page Special Authorization document that must be completed and signed by a doctor, nurse practitioner or certified diabetes educator. Please ensure it is complete and signed prior to submitting the application.
How long am I approved for?
You or your loved one will be eligible for benefits for up to one year. Benefits will end each year on June 30th, regardless of your approval date.
You will need to re-apply by June 30th each year to continue your benefits coverage and may do so any time between April 1st and June 30th. When reapplying, your income tax for the previous year must have been filed with the Canada Revenue Agency
Coverage will be continued as long as you or your loved one continue to meet the eligibility criteria.
Where can I get my Dexcom CGM supplies?
Once enrolled for benefits under the Glucose Sensor Program, you must purchase your CGM supplies at your local pharmacy.
Will I have any out-of-pocket costs?
If you have private health insurance that provides partial coverage for glucose sensors, your co-payment will range from $0 to $16 per dispense depending on your household income, or the amount remaining after payment by your private insurance, whichever is less.
If you don’t have private health insurance, your co-payment will range from $0 to $80 per dispense depending on your household income.
The Dexcom G7 Patient Benefit Program can assist you in reducing or even eliminating your copay, up to 20% of out-of-pocket costs. Download a copy of the program certificate below, which can be redeemed at your pharmacy with a valid Dexcom G7 prescription.
Do you have questions?
Our team is here to help! One of our Insurance Specialists can assist you in determining your coverage for Dexcom CGM. Get started by filling out our online form or call us at 1-844-832-1810.
*Based on reasonable upcharge, mark-up and customary pharmacy dispensing fee.
† Best available information as of June 14, 2024. Subject to change.
† Best available information as of June 14, 2024. Subject to change.